1. On-the-job employees: the deductible for outpatient service is 2000 yuan, that is, the medical expenses incurred in outpatient service that exceed 2000 yuan will be reimbursed, and the reimbursement ratio is 50%;
2. Retired employees: the outpatient fee-free amount is 1.300 yuan, that is, the part of medical expenses incurred in outpatient service that exceeds 1.300 yuan will be reimbursed.
First, the main purpose of the medical insurance card
1, the main purpose of medical insurance is to pay for outpatient treatment.
2. Medical insurance has other uses. You can use this money to buy medicines (over-the-counter medicines), medical instruments, thermometers and sphygmomanometers at designated pharmacies. You can also pay for self-funded items such as physical examination.
As we all know, employee medical insurance is generally divided into personal accounts and overall accounts. How to use these two accounts respectively?
1. Drug purchase expenses of designated retail pharmacies, outpatient and emergency medical expenses;
2. Used to purchase commercial insurance and accident insurance;
3 basic medical insurance fund Qifubiaozhun below the medical expenses;
4 more than the basic medical insurance fund Qifubiaozhun, the expenses borne by individuals in proportion;
5. I'll pay for the part of my personal account that is insufficient to pay.
Two, the overall fund mainly pays the following fees:
1, hospitalization expenses;
2, malignant tumor radiotherapy, renal dialysis, kidney transplantation after taking anti-rejection drugs outpatient medical expenses;
3, emergency rescue income hospitalized patients, the medical expenses within seven days before hospitalization.
Third, the scope of medical insurance reimbursement
1, medical insurance card reimbursement is limited to medical expenses above hospitalization in designated hospitals due to diseases and some accidents.
The reimbursement formula is: (total cost-threshold cost-self-funded cost-cost overrun) *(75+ age *0.2)%. In general, the actual reimbursement rate ranges from 20% to 60%.
Self-funded drugs are not reimbursed, and 80% of Class B drugs are reimbursed. Bed fees are limited, and some inspection fees and medical treatment fees cannot be reimbursed according to regulations.
2. The reimbursement amount of the medical insurance card is 4 times of the local social wage (1 year accumulated value).
3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account.
4. Reimbursement of serious illness insurance
After the insured suffers from a serious illness, the personal conceit part that meets the requirements of the municipal medical insurance in the designated medical institutions of the municipal medical insurance shall be included in the payment scope of the residents' serious illness insurance, and 50% shall be reimbursed by the serious illness insurance fund.
That is, reimbursement amount = self-funded part ×50%
legal ground
People's Republic of China (PRC) social insurance law
Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.
Article 24 The state establishes and improves the new rural cooperative medical system.
Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.
Article 25 The state establishes and improves the basic medical insurance system for urban residents.
The basic medical insurance for urban residents combines individual contributions with government subsidies.
People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.